GI: Small and Large Intestine

Question 1

True or false: the small intestine has goblet cells

Answer 1

true

Question 2

Brunner’s glands are specific to which part of the small intestine?

Answer 2

duodenum

Question 3

_________ ______ are specific to the ileum

Answer 3

Peyer’s patches

Question 4

What is the big function of the large intestine?

Answer 4

water absorption

Question 5

True or false: there are goblet cells in the large intestine

Answer 5

TRUE

Question 6

What are the general layers of the GI tract?

Answer 6

epithelium
lamina propria
muscularis mucosa
submucosa
muscularis propria (circular muscle --> myenteric plexus --> longitudinal)
serosa/adventitia

Question 7

What is gastroschisis?

Answer 7

extrusion of abdominal contents thru abdonimal folds (NO peritoneum)

Question 8

What is omphalocele?

Answer 8

persistence of herniation of abdominal contents into umbilical cord - sealed by peritoneum

Question 9

Define intussusception

Answer 9

bowel telescopes into distal segment (usually at ileocecal junction)

Question 10

What are symptoms of intussusception?

Answer 10

abdominal pain with current jelly stools (usually in kids)

Question 11

What is the name of the condition when the bowel twists around the mesentery?

Answer 11

volvulus

Question 12

What is the most common acquired GI emergency in premature or low birth weight babies?

Answer 12

necrotizing enterocolitis

in small and large intestines, terminal ileum and ascending colon

Question 13

What is Meckel’s Diverticulum?

Answer 13

persistence of omphalomesenteric duct (disease of 2s)

Question 14

What is Hirschprung Disease?

Answer 14

absence of ganglion cells (premature arrest of neural crest cells migrating from the cecum to rectum

MISSING ENTERIC NEURONS (do biopsy to look for these - need to get to muscularis propria)

Question 15

What are some signs of malabsorption?

Answer 15

chronic diarrhea
steatorrhea
weigh loss
abdominal pain

Question 16

Define steatorrhea

Answer 16

72 hour fecal fat (>7 grams/24 hours), voluminous, malodorous

Question 17

What symptoms can malabsorption lead to?

Answer 17

anemia (not enough B12, folate)
bleeding (not enough vit. K)
osteopenia and tetany (not enough Ca, Mg, Vit. D)
peripheral neuropathy (not enough vit. A and vit. D)

Question 18

What is the most common disaccharidase deficiency?

Answer 18

lactase deficiency (leads to osmotic diarrhea)

Question 19

What makes a lactose tolerance test positive?

Answer 19

administration of lactase producing symtoms

glucose rises to

Question 20

What is abetaliporproteinemia?

Answer 20

decreased synthesis of apolipoprotein B (decreased ability to generate chylomicrons, decreased secretion of cholesterol)

Question 21

What is the main physiological problem in celiacs?

Answer 21

damage to small intestine when gluten is consumed

Question 22

What are some symptoms of celiacs?

Answer 22

diarrhea, weight loss, abrominal pain

dermatitis herpeformis

Question 23

What is a main giveaway symptom of celiacs that presents on the skin?

Answer 23

dermatitis herpetiformis (skin blistering due to Ig deposition)

Question 24

What does celiacs look like on endoscopy?

Answer 24

atrophic mucosa (atrophied folds)

Question 25

Which disease is associated with flattening of the villi?

Answer 25

celiacs

Question 26

What is a big finding on biospy/histology of celiacs?

Answer 26

increased number of intraepithelial T lymphocytes (CD8)

Question 27

What is another disease that looks similar to celiacs but can be treated with antibiotics

Answer 27

tropical sprue (unknown cause)

Question 28

What are signs of acute colitis?

Answer 28

neutrophils in epithelium and lamina propria

Question 29

What are some bacteria that can cause acute colitis?

Answer 29

``` cholera campylobacter shigella salmonella typhid yersinia e coli ```

Question 30

What are 2 viral causes of acute colitis?

Answer 30

norovirus | rotavirus (mostly kids - severe diarrhea)

Question 31

What are 3 parasites/protozoa that cause GI problems?

Answer 31

nematodes (ascaris) flatworms protozoa (giardia, entamoeba histolytica)

Question 32

What GI condition commonly follows a course of broad spectrum antibiotics?

Answer 32

pseudomembranous colitis

Question 33

What does pseudomembranous colitis look like on histology?

Answer 33

mushroom shaped protrusion over the normal mucosa

Question 34

What is a common GI problem that occurs in middle aged females but looks normal on endoscopy?

Answer 34

collagenous colitis

Question 35

How does collagenous colitis present?

Answer 35

chronic watery diarrhea (3-20 non bloody stools per day)

Question 36

How do you diagnose collagenous colitis?

Answer 36

histology (trichrome stain - look for collagen and look for lymphocytes in epithelium)

Question 37

Which form of colitis has a strong association with autoimmune diseases?

Answer 37

lymphocytic colitis

Question 38

If both feature symptoms of chronic diarrhea and passage of non bloody stool, what is the difference between lymphocytic and collagenous colitis?

Answer 38

lymphocytic: males and females equally collagenous: females more (stains on trichrome)

Question 39

What is Whipple's Disease?

Answer 39

gram positive rod shaped actinomycete (tropheryma whippleli) engulfed by macs leads to malabsorption, lymphadenopathy, arthritis

Question 40

What is the pathogenesis of Whipples?

Answer 40

foamy macs distend the villi so vessels and lymphatics become congested --> poor absorption and function of villi)

Question 41

What is a potential cause of IBD

Answer 41

reduced enteric infections leading to inadequate development of gut immune response

Question 42

What are some symptoms of Crohns?

Answer 42

intermittent attacks of mild diarrhea, fever, abdominal pain, recurrent attacks or flare ups of diarrhea (can present abruptly with RLQ pain) NON BLOODY

Question 43

True or False: Crohn's can occur at any point along the GI tract

Answer 43

true (but usually ileum or ileocecal valve) segmented involvement which spares some areas

Question 44

What does crohn's look like on gross?

Answer 44

ulcerated mucosa and fistula formation

Question 45

What does Crohn's look like on histology?

Answer 45

transmural inflammation, cryptitis, crypt abscesses, ulceration, non-caseating granulomas

Question 46

What is ulcerative colitis?

Answer 46

relapsing attacks of mucoid diarrhea WITH pain (can have an explosive initial attack with serious bleeding)

Question 47

What are 2 complications of ulcerative colitis?

Answer 47

- primary sclerosing cholangitis | - cancer

Question 48

How does the inflammation of UC differ from Crohn's?

Answer 48

inflammation of mucosa that is continuous (diffuse - begins at rectum and progresses proximally)

Question 49

What does the early phase of UC look like?

Answer 49

neutrophils and crypt abscesses

Question 50

What does the later phase of UC look like?

Answer 50

mucosa ulcerates and pseudo polyps form

Question 51

What does the LATE phase of UC look like?

Answer 51

atrophy and possible dysplasia

Question 52

True or false: UC is transmural

Answer 52

FALSE (only in mucosa/submucosa)

Question 53

What are the main differences between UC and Crohn's?

Answer 53

Crohn's is transmural UC is only mucosa/submucosa Crohn's is non bloody UC is bloody Crohn's is any part of GI (skipped areas) UC is diffuse

Question 54

What are some extraintestinal complications with Crohn's?

Answer 54

migratory polyarthritis kidney stones

Question 55

What are some extraintestinal complications with UC?

Answer 55

primary sclerosing cholangitis